Unconsciousness
Definition
This is an abnormal state resulting
from an interruption of the brain’s normal function.
The loss of consciousness can be
caused by many things ranging from harmless, temporary fainting due to poor
circulation to the brain to the most extreme comatose conditions. Any interference
with the brain’s blood supply or physical damage to the brain will result in
consciousness.
Regardless of the cause,
unconsciousness entails life-threatening risk of respiratory failure due to
nervous system involvement.
The severity or degree of unconsciousness
can be assessed by evaluating the victim’s level of response to stimuli such as
command, touch or pain.
Degrees
of Unconsciousness
Semi-Consciousness
- Appears drowsy and confused
- Response to calls
- Reacts to pain
Coma
- Unresponsive to call
- May not respond to painful stimulus
- No muscle tone in extremities or limbs (flaccid).
- Unable to maintain owns airway
- Lack of breathing may be present
Example:
Alcohol Intoxication Head Injury
Asphyxia Hypoxia
Chest
Injury Heatstroke
Drug
Abuse Poisoning
Diabetes Severe
Bleeding
Electrical
Injury Seizures
Heart
Attack Stroke
Management
of an Unconscious Victim
It is important to carry out the
first aid skill promptly and safely to help save someone’s life or prevent an
urgent problem from becoming a life-threatening emergency. Whatever the cause,
do the initial assessment by following the mnemonic steps of DRABC.
Danger
– Scene Safety and Personal Protection.
Ensure no danger at the scene to
yourself and victim.
Observe Universal Precautions by using
protective equipment e.g.: wear gloves, standby the Air-Viva resuscitator.
Response
– Check for Responsiveness
Shake victim’s shoulders and call
out “Are You OK? Are You Alright?”
If
victim is unresponsive: Call for help immediately.
Begin the ABC rule of checking the victim’s airway, breathing and circulation
after receiving no response from the victim.
Airway
– Open the Airway
When the victim is unresponsive, the
muscles of the jaw and neck relax allowing the tongue to fall back against the
throat and block the airway. The tongue
is the most common cause of a blocked
airway in an unresponsive victim, the tongue is attached to the lower jaw.
There are 2 methods to pull the tongue away from the back of the throat and
open the airway.
Two
Methods of Opening the Airway
1. Head Tilt-Chin Lift
Place
one hand on the forehead and place the fingers of your other hand under the
bony part of the lower jaw near the chin. Push down on the forehead and lift
the chin up and forward. Do not press deeply into the soft tissue under the
chin as this might obstruct the airway. After opening the airway, if you see
anything in the victim’s mouth such as food or vomitus, remove it by using
finger sweeps.
2. Jaw Thrust
If you suspect
that victim has head or neck injury such as someone who has fallen from a
height, has had a motor vehicle accident or someone with evidence of trauma;
use the jaw thrust to open the airway. Do not use the head tilt because it may
worsen injury to the spinal cord. Grasp both the angles of the victim’s lower
jaw with your fingers and lift the jaw upward without tilting the head.
Breathing –
Check for Breathing (10 seconds)
After the airway is opened, is the
victim breathing? Check for breathing by looking, listening and feeling. To do
this, place your ear near the victim’s mouth and nose while maintaining an open
airway and observe the chest:
- Look for chest movement.
- Listen for sounds of breathing.
- Feel for the flow of air on your cheek
This evaluation procedure should
take no more than 10 seconds.
NOTE:
If
the victim has a normal breathing:
Administer oxygen therapy and
conduct a physical examination. Place the victim in the recovery position to
keep the airway open if there are so signs of spinal injury or trauma.
Circulation
An unconscious victim, who is
breathing normally, is known to have the presence or circulation. If you can
identify signs of normal breathing, coughing or movement present, this means
the victim’s heart is beating adequately to supply blood to the body. Continue
to monitor victim’s breathing and circulation throughout the period of
unconsciousness.
Physical
Examination
After the steps of DRABC are
completed and there is no immediate treat to life, proceed to do the secondary
assessment by performing a physical examination on the victim’s body from head
to toes. Look for body injuries such as deformity, open wounds and swelling as
well as any medical clues e.g. the medic-alert tag.
Establish the cause of
unconsciousness if possible and treat any injury accordingly.
If there is no suspected spinal cord
injury or evidence of trauma, place the unconscious victim who has a normal
breathing in the recovery position. Monitor breathing and circulation closely.
Recovery
Position
The unconscious victim who is
breathing normally is placed in the recovery position for the following
purposes:
To maintain an open airway. This position
prevents the tongue from falling backwards and blocking the airway.
To allow saliva or vomitus to drain
freely from the mouth, thus reducing the risk of inhaling the stomach contents.
CAUTION:
DO
NOT turn a victim with neck or spinal injury into the recovery position.
- Do not leave an unconscious victim unattended.
- Do not give anything by mouth.
- Do not move the victim unnecessarily.
- Continue to maintain an open airway, monitor the breathing and circulation and record the vital signs every 10 – 15 minutes.
- Administer high-flow oxygen.
- Keep victim warm, observe skin colour and temperature.
- Standby emergency first aid resuscitative equipment.
- Seek urgent advanced medical care.